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J Mol Biochem. Author manuscript; available in PMC 2016 August 24. Published in final edited form as: J Mol Biochem. 2016 ; 5(2): 63–70.

The effectiveness of a stress-management intervention program in the management of overweight and obesity in childhood and adolescence

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Stavroula Stavrou1, Nicolas C. Nicolaides2,3, Ifigenia Papageorgiou2, Pinelopi Papadopoulou2, Elena Terzioglou2, George P Chrousos1,2,3, Christina Darviri1,*, and Evangelia Charmandari2,3,* 1Postgraduate

Course Stress Management and Health Promotion, School of Medicine, University of Athens, Athens, 11527, Greece

2Division

of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, University of Athens Medical School, ‘Aghia Sophia’ Children’s Hospital, Athens, Greece

3Division

of Endocrinology and Metabolism, Clinical Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, 11527, Greece

Abstract

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Background—Obesity in childhood and adolescence represents a major health problem of our century, and accounts for a significant increase in morbidity and mortality in adulthood. In addition to the increased consumption of calories and lack of exercise, accumulating evidence suggests that childhood obesity is strongly associated with prolonged and excessive activation of the stress system. Aim—The aim of our study was to assess the effectiveness of a stress-management intervention program, which included progressive muscle relaxation, diaphragmatic breathing, guided imagery and cognitive restructuring, in overweight and obese children and adolescents.

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Methods—Forty-nine children and adolescents (mean age ± SEM: 11.15 ± 1.48 years) were prospectively recruited to participate in this randomized controlled study. Of those, 23 participants were assigned into the intervention group, while 26 participants represented the control group. Anthropometric measurements were recorded at the beginning and at the end of the study, and participants were asked to complete the Screen for Child Anxiety Related Disorders (S.C.A.R.E.D.), the Child Depression Inventory (C.D.I.), the Child Behavior Checklist (C.B.C.L.) and the Youth Self Report (Y.S.R.). Results—The applied stress-management methods resulted in a significant reduction in the body mass index (BMI) in the intervention group compared with the control group [ΔBMI=1.18 vs 0.10 kg/m2 (p0.60 (Giannakopoulos et al. 2009). Child Behavior Checklist (C.B.C.L.)

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The C.B.C.L. is a well-known questionnaire provided by Achenbach and Edelbrock. It is filled in by parents and is used to evaluate internalizing and externalizing symptoms in children. It consists of 113 questions on specific behavioral problems and parents were asked to score each behavioral item from 0 to 2 depending on the frequency (Aschenbach et al. 1991a). The C.B.C.L. had been translated in the Greek language and the internal consistency for internalizing and externalizing problems was 0.90 and 0.94, respectively (Roussos et al. 1999). Youth Self Report (Y.S.R.) The Y.S.R. is completed by adolescents, who evaluate their own internalizing and externalizing symptoms. It consists of 112 items that are scored from 0 to 2 depending on the frequency of each symptom (Aschenbach 1991b, c). The internal consistency for both internalizing and externalizing symptoms was 0.90 in the Greek version (Roussos et al. 2001).

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Routine, Daily Habits, Life Satisfaction Daily routine of the participants was assessed with questions concerning: a) daily sleep; b) breakfast; c) lunch; d) dinner. Participants were asked to give possible answers ranging from “never” to “always”, as well as to report the regularity of issues of their routine (e.g. “do you have a standard time in eating breakfast every day?”). Total routine was calculated by summing all the answers ranging from 1 “never” to 4 “always”. Daily routine was assessed both at the beginning and at the end of the study. Daily habits were assessed with a 4-point scale ranging from 1 “never” to 4 “always” for questions concerning eating behavior, physical exercise, participation in sports e.t.c.

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Life satisfaction was evaluated with a 5-point scale ranging from 1 “not at all” to 5 “very much”. Participants were asked to rate their satisfaction about friendship, school, family, self-image, free time e.t.c. Statistical Analysis Continuous variables were summarized with the use of descriptive statistical measures (mean value, standard deviation (SD) and range). Categorical variables were displayed as frequencies and percentages (n, %). The normality of distribution of continuous variables was examined using the Kolmogorov-Smirnov test in order to determine whether or not to use parametric methods for the analysis of the sample data. Association between categorical J Mol Biochem. Author manuscript; available in PMC 2016 August 24.

Stavrou et al.

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variables was assessed using χ2 (chi-square test). Furthermore, in order to examine the differences in mean values of variables, the t-test or the Mann-Whitney U test for independent samples was applied. All the aforementioned statistical tests were two-sided and performed at a 0.05 significance level. Data were analyzed using the SPSS statistical package version 21.0 (SPSS, Chicago, IL).

Results Demographic, anthropometric and baseline data for the participants

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The demographic, anthropometric and baseline data for the participants are presented in Table 1. Twenty-three and twenty-six children and adolescents were assigned in the intervention and control group, respectively. The mean age of the participants was 11.15 ± 1.48 years. Twenty-four of the participants were boys and twenty-five were girls. All of them were students of primary or high school. The mean BMI was 27.11 ± 4.27 kg/m2 with no significant statistical difference between the two groups (p=0.575). Moreover, the waistto-hip ratio of the participants in the intervention group was similar to that of the control group (0.92 vs. 0.93; p=0.748). In addition to the demographic and anthropometric data, the two groups showed statistical significant differences with respect to scores of the C.D.I., C.B.C.L. and Y.S.R. questionnaires. These differences could be attributed to the small size of samples. However, no differences were found between the intervention and control group for internalizing and externalizing problems, both in children and parents. Stress-management methods facilitated weight loss in overweight and obese children and adolescents

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The applied stress-management methods resulted in a significant reduction in the BMI in the intervention group compared with the control group (mean difference of BMI (ΔBMI) = 1.18 vs. 0.10 kg/m2; p

The effectiveness of a stress-management intervention program in the management of overweight and obesity in childhood and adolescence.

Obesity in childhood and adolescence represents a major health problem of our century, and accounts for a significant increase in morbidity and mortal...
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